Objective: The objective of this study is to investigate whether preeclampsia is associated with exacerbation of insulin resistance. Materials and Methods: The study was conducted over a period of 7 months from November 2011 to May 2012, in a tertiary care hospital attached to a medical college. A total of 14 pregnant women in the third trimester with preeclampsia were recruited for this study and 14 well-matched normotensive women in the third trimester were taken as control. 15 g, 50% dextrose load was given intravenously and blood sampling was carried out for glucose and insulin levels up to 3 h afterward. Minimal model analysis of glucose and insulin levels was performed to arrive at results. Results: No significant changes in mean age, body mass index, gestation, serum lipid and progesterone, cortisol and androgen concentrations were recognized. No significant difference was found between the glucose decay curves and between the glucose clearance rate K, in the two groups (preeclamptic vs. normotensive: 2.1 ± 0.2 vs. 2.2 ± 0.3; P = 0.48). Therefore, there was a small but prolonged decrease in the insulin response of women with preeclampsia compared with women in the normotensive group. Conclusion: Preeclampsia per se is not a risk factor for development of insulin resistance.

Chikungunya is an arboviral disease transmitted by Aedes mosquito that represents a major public health burden worldwide including India. The disease presents as sudden onset of high-grade fever, severe arthralgias, and rash. Here, we describe a case of a patient who presented with cervical lymphadenopathy, fever, and myalgia and later was diagnosed as chikungunya. Lymphadenopathy has been described before as a less common symptom of chikungunya. But this is probably, the first case of chikungunya with cervical lymphadenopathy as a presenting feature.

Background: Growth of mentally retarded children differs from that of normal children. However, the adolescent growth and development of Indian mentally retarded children has not been studied. Aim: This study was conducted to evaluate the physical growth and sexual development of adolescent mentally retarded girls in North Indian population and to compare it with that of normal girls of same age group. Materials and Methods: One hundred mentally retarded (intelligence quotient (IQ) less than 70) and 100 normal girls between 10 and 20 years of age were categorized into 1-year age groups. Their height was measured and the sexual development was assessed based on breast development (BD) and pubic hair growth (PH) stages 1-5 on the basis of Tanner scale. The data was then compared between the two groups using Student's t-test. The mean age of menarche was calculated by applying Probit analysis. Results: The mean height of mentally retarded girls was significantly retarded as compared to normal girls at all ages; however, the mean height gain during 11-20 years was same in both the groups. The mentally retarded girls also showed significant retardation in PH growth at 15-17 years and in BD at 15-16 years of age. Conclusions: The physical growth and sexual development of adolescent mentally retarded girls was retarded as compared to the normal girls. The physical growth retardation occurred during early childhood (before 11 years), however the retardation in sexual maturity occurred during middle adolescence, between 15-17 years of age.

Background: Medication errors are prevalent in the hospital settings. To ensure the patient safety and provide better health services, medication errors should be curbed. India is still lacking the regulatory system for the control of medication errors. Therefore, a stringent regulatory set up should be established to reduce medication errors. Awareness among the health-care professionals regarding medication errors may be the major factor in the establishment of successful regulatory system. In Indian context, no study has been reported about the awareness of medication errors. Therefore, this study assessed the awareness of the health-care professionals representing North, East and West regions of India about medication errors. These health-care professionals also included the students who were in the final phase of professional courses related to health management. Materials and Methods: A questionnaire comprising of 17 questions pertaining to different aspects of medication errors was prepared. Questionnaire was distributed to 456 health-care professionals of various institutes of North, East and West India. Respondents of the questionnaire were restricted to one sitting for answering the entire questionnaire and they were not allowed to consult with anyone for the purpose of answering the questions. Data was compiled and analyzed. Results: It has been found that 18.45%, 39.48%, 14.16%, 27.9% of respondents were having excellent, good, average, poor knowledge respectively regarding the fundamentals of medication error. Knowledge regarding reporting medication errors was excellent in 56.65%, good in 22.53%, average in 09.23% and poor in 11.59% of respondents. Conclusion: The outcome of this study may be of great help in drafting the regulatory policies to curb the problem of medication errors.

Introduction: In the conventional system of medical education, basic subjects are taught in the 1 st year with least interdisciplinary interaction. The objective of this study was to explore the students' perception about content, need and application of basic science subjects during the clinical years of their medical education. Materials and Methods: A total of 300 questionnaires were distributed among students randomly after taking their written consent for participation in the study. About 265 completely filled questionnaires were received back and the response was analyzed. Results: Students identified anatomy as the subject with overloaded syllabus (75.4%) and also with maximum clinical application with 50.1% of them considering it the most important basic subject. Students were satisfied with the practical integration of subjects to impart clinical skills, but considered problem based learning a better method of teaching. According to 37%, 43.8% and 33.2% of respondents respectively; anatomy, biochemistry and physiology curriculum should only cover the general concepts to give the working knowledge of the subject. Approximately, 65% of the respondents were able to recall the knowledge of anatomy and physiology while biochemistry was retained by 40%. Conclusions: Overall, the attitudes of students toward basic science subjects were positive. The learning experience for them can be improved significantly by better clinical integration of the subjects.

Background: Magnesium is one of the major electrolytes, deficiency of which is frequently overlooked in critical illness, leading to an adverse clinical outcome if not monitored regularly. Settings and Design: Single center prospective observational study of 2 years duration. Materials and Methods: The subjects studied were monitored for serum magnesium levels 2 times: Day 1 and day 4 of intensive care unit (ICU) admission. Patients were divided into normomagnesemic and hypomagnesemic groups and compared for various parameters. Results: Out of 70 critically ill-patients, 50 patients (71.43%) were normomagnesemic, 17 patients (24.29%) were hypomagnesemic and three patients were hypermagnesemic. The stay of the patients in ICU (P > 0.05), Acute Physiology and Chronic Health Evaluation-II (APACHE-II) scoring (P = 0.34) and co-morbidity (P = 0.360) showed an insignificant variation between the two groups. Associated electrolyte abnormalities in hypomagnesemic patients were hypokalemia (58.82%), hyponatremia (47.05%), hypocalcemia (70.58%) and hypophosphatemia (29.41%). About 76.47% of hypomagnesemic population was on magnesium lowering drugs while as 46% of normomagnesemic population was on magnesium lowering drugs (P = 0.030). Mortality of hypomagnesemic group was 74.47% while that of normomagnesemic group was 36% (P = 0.004). Conclusion: Hypomagnesemia is a significant electrolyte abnormality in critically ill-patients. Critically ill hypomagnesemic patients have higher mortality than the normomagnesemic patients.

Primary squamous cell carcinoma (SqCC) of the breast is a very rare tumor accounting for less than 0.1% of all invasive breast carcinomas. This is a very aggressive, hormone receptor negative and treatment refractory tumor with poor prognosis. We report a case of primary SqCC of the breast in a 72-year-old postmenopausal lady who presented with a lump in the right breast. The treatment of primary SqCC of the breast does not differ from other common histological types of breast cancer and may involve surgery, chemotherapy, hormonal therapy and radiation therapy. Clinical trials including large series of these rare tumors are needed to increase our knowledge and to improve patient's outcome.

Effect of prenatal chronic noise exposure on the growth and development of body and brain of chick embryoAlpana Goel KesarJanuary-June 2014, 4(1):3-6DOI:10.4103/2229-516X.125666 PMID:24600569

Context: Noise acts as an environmental stressor as has been demonstrated by an increased brain acetyl cholinesterase activity as well as elevated plasma corticosterone and adrenocorticotropic hormone levels. Noise can lead to neurodegenerative changes in the brain and in the ear. Aim: This study was undertaken to investigate the effect of chronic noise on growth and development during the sensitive period of embryonic life. Materials and Methods: In this study, we analyzed the body weight, brain weight and brain size following prenatal chronic noise exposure. Fertilized eggs of domestic chicks were exposed to chronic excessive acoustic stimulation with frequency of the sound ranging from 30 to 3000 Hz with a peak at 2700 Hz was given at 110 dB sound pressure level from embryonic day (E) 10 until hatching. Results: An appreciable decrease in body weight, brain weight and brain size was evident in the experimental group exposed to noise. A generalized decrease in the neuronal nuclear size and increase in the density of neurons was also observed. Conclusion: These observations could be an indicator of growth and developmental retardation following exposure to noise.

Background: Myocardial infarction is the third leading cause of death in the developing countries. Thrombolysis as a reperfusion therapy is shown to have a great role in decreasing mortality. The efficacy of thrombolytic therapy lies in its ability to reduce the duration of occlusion by early administration. Many of the studies have supported pre-hospital thrombolysis (PHT) therapy and proven that it is beneficial in acute myocardial infarction (AMI) patients. Methodology: Questionnaires adopted from studies of Humphrey etal., were distributed to paramedics in Saudi Red Crescent Authority and Emergency Medical Services Departments at King Abdulaziz Medical City, King Fahad Medical City, Prince Sultan Medical Military City and Security Forces Hospital in Riyadh. A total of 7 questions were about the knowledge of risk and benefit of PHT and 12 questions were about the beliefs and attitudes of paramedics toward PHT in AMI patients. Results: The response rate was 87%. Nearly 72% were believed to be capable of performing PHT, 87% are confident about recording 12-lead electrocardiogram in pre-hospital settings and 77% are confident in the interpretation. 94% believe that PHT will have a significant impact on pain to needle time. 77% consider PHT to be safe for use by paramedics. 66% preferred on-line medical direction or telemedicine linked with the supervision of a physician. Regarding the knowledge part, majority gave a correct answer, but the major concern was that 43% of the paramedics overestimated direct relation of bleeding to thrombolysis therapy. Conclusion: Majority of paramedics in Riyadh support the principle of PHT in patients with AMI via online medical direction. They believe that they are confident in their ability to administer PHT despite the concern of authorities on their level of training, the related risks and medico-legal issues. Nevertheless, since the total duration of PHT course for paramedics is just 2 days, we consider that the procedure should be performed under expert supervision until they achieve expertise.

Background: One of the postulated mechanism for cardioprotective potential of isoflavones is their ability to exert antioxidant action. However, various reports give conflicting results in this area. Aim: The present study was conducted with an objective to probe into the cardioprotective mechanism of isoflavones by evaluating their antioxidant potential in oophorectomized women. Materials and Methods: This was a randomized, double-blind, parallel, placebo controlled study. A total of 43 women were randomized to receive 75 mg/day isoflavones tablet or placebo for 12 weeks. Red blood cell antioxidant parameters including lipid peroxidation, superoxide dismutase (SOD), catalase and glutathione peroxidase (GSH-Px) were determined at baseline and at the end of the study. Results: After 12 weeks of administration of isoflavones, there was no statistically significant difference in lipid peroxidation (P value for isoflavones: 0.37; for placebo: 0.37), catalase (P value for isoflavones: 0.35; for placebo: 0.84), SOD (P value for isoflavones: 0.41; for placebo: 0.28) and GSH-Px (P value for isoflavones: 0.92; for placebo: 0.29). There was no statistically significant difference in the proportion of patients experiencing adverse events in the two groups (P -1.00). Conclusion: The study strengthens the concept that the cardioprotective mechanism of isoflavones might be due to some other reason apart from the antioxidant pathway.

Botulism is a dreadful, life-threatening, neuroparalytic disease caused by gram positive bacteria Clostridium botulinum. Food borne botulism has been described following ingestion of preformed toxins in canned food or food products that have not been preserved properly. Botulinum toxin acts on neuromuscular junction and manifests as ophthalmoplegia, bulbar and limb weakness, and autonomic features along with respiratory compromise. The literature and case reports regarding neuroparalytic botulism in India are sparse. Generalized fasciculations have been rarely reported in literature as manifestation of food borne botulism. We present a 35-year-male presenting with usual features described, but with prominent generalized fasciculations which are rare, and which rapidly responded to treatment.

Aims and Objectives: The objective of this study is to review the clinical profile and outcome in patients requiring the angiographic embolization in obstetrics. Methods: The retrospective data of patients requiring uterine artery embolization for control of obstetrical hemorrhage was studied during the period from August, 2005 to August, 2010. Results: A total of 35 patients with obstetrical hemorrhage (seven post lower segment caesarean section, 13 post vaginal delivery, 13 postabortal, one with cervical pregnancy and one patient post laparotomy for abdominal pregnancy) underwent angiographic embolization for control of bleeding. In all patients, hemorrhage was successfully controlled; none required post procedure hysterectomy and one patient subsequently became pregnant with in a year. Conclusion: Our clinical experience suggests that embolization is superior first-line alternatives to surgery for control of obstetric hemorrhage including postpartum, post-cesarean and postabortal bleeding and prevents hysterectomy.

Closed circuit suction system (CCSS) has become a standard of care for the tracheal suctioning of mechanically ventilated patients. The advantages of CCSS over the open suction system include decreased environmental, personnel and patient contamination, preservation of lung volumes and oxygenation especially in the severely hypoxemic patients. On the other hand, CCSS has lower efficacy in removal of secretions and it may have certain other disadvantages due to the invisibility of its tip. We report an unusual case of an airway foreign body causing blockage of the CCSS leading to retained secretions and deterioration of patient. Timely changing over to open suction system helped in its detection and improvement of patient.